<!DOCTYPE html>
<html xmlns:th="http://www.thymeleaf.org"
      th:replace="fragments/layout(title='离住记录-新增',jsPaths='/static/js/elder/checkoutrecords/add.js')">
<div class="right" th:fragment="right">
            <!--面包屑-->
            <div class="breadcrumb layui-bg-gray">
                <span class="layui-breadcrumb" lay-separator=">">
                    <a th:href="@{/}">首页</a>
                    <a href="">客戶管理</a>
                    <a href="/checkoutrecords">离住记录</a>
                    <a><cite>新增</cite></a>
                </span>
            </div>

            <!--主体内容区-->
            <div class="form-content layui-container">
                    <form class="layui-form" th:action="@{/checkoutrecords/save}" method="post">
                        <div class="layui-form-item">
                            <label class="layui-form-label must">老人姓名</label>
                            <div class="layui-input-block">
                                <input type="text" th:value="${elderly.name}" name="elderlyName"    lay-verify="required"  autocomplete="off" class="layui-input layui-disabled">
                                <input type="hidden" name="elderlyId" th:value="${elderly.id}">
                            </div>
                        </div>

                        <div class="layui-form-item">
                            <label class="layui-form-label must">楼号</label>
                            <div class="layui-input-block">
                                <input type="text"  name="buildingNo" th:value="${checkInRecords.buildingNo}"  readonly   lay-verify="required"  autocomplete="off" class="layui-input layui-disabled">
                            </div>
                        </div>
                        <div class="layui-form-item">
                            <label class="layui-form-label must">房间号</label>
                            <div class="layui-input-block">
                                <input type="text"  name="roomNo" th:value="${checkInRecords.roomNo}"  readonly   lay-verify="required"  autocomplete="off" class="layui-input layui-disabled">
                            </div>
                        </div>
                        <div class="layui-form-item">
                            <label class="layui-form-label must">床号</label>
                            <div class="layui-input-block">
                                <input type="text"  name="bedNo" th:value="${checkInRecords.bedNo}" readonly   lay-verify="required"  autocomplete="off" class="layui-input layui-disabled ">
                                <input type="hidden" name="bedId"  th:value="${checkInRecords.bedId}">
                            </div>
                        </div>
                        <div class="layui-form-item">
                            <div class="layui-input-block">
                                <button class="layui-btn" lay-submit lay-filter="submitBtn">确定离住</button>
                                <a href="/elderly" class="layui-btn layui-btn-primary">返回</a>
                            </div>
                        </div>
                    </form>

            </div>
        </div>
</html>